Ilhan Inci

Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemas.

BACKGROUNDnProgression of empyema, with the development of fibrinous adhesions and loculations, makes simple drainage difficult or impossible. The appropriate management remains controversial. Intrapleural fibrinolytic treatment to facilitate drainage of loculated empyema instead of open thoracotomy has been advocated since the 1950s. The aim of this study was to assess the effectiveness of intrapleural fibrinolytic treatment in postpneumonic pediatric empyemas.nnnMETHODSnIn our clinic, we used intrapleural fibrinolytic agents in 72 pediatric patients with multiloculated empyema between 1994 and 2002. Streptokinase, 250,000 U in 100 mL of 0.9% saline solution (59 patients), and urokinase, 100,000 U in 100 mL of 0.9% saline solution (13 patients), were instilled daily into the chest tube, and the tube was clamped for 4 hours followed by suction. This treatment was continued daily for 2 to 10 days until resolution was demonstrated by chest radiograms or computed chest tomography.nnnRESULTSnThe rate of drainage after fibrinolytic treatment was increased 73.77%. Treatment was ineffective in 14 (19.44%) of 72 patients who underwent fibrinolytic instillation. Treatment was discontinued because of allergic reaction and pleural hemorrhage in 1 patient, and because of development of bronchopleural fistula in another one. The regimen was completely successful in 43 (59.72%) patients, and partially successful in another 15 (20.83%). Twelve of those patients who had failure eventually required decortication and recovered completely. One patient died of sepsis and pleural hemorrhage; another patient died because of food aspiration.nnnCONCLUSIONSnIn all patients with loculations except those with a bronchopleural fistula, intrapleural fibrinolytic treatment should be tried. Thus, the majority of children with loculated empyemas can be treated successfully without invasive interventions, such as thoracoscopic debridements or open surgery.

Myoepithelioma of the lung

A 54-year-old woman with myoepithelioma, a very rare tumor of the lung, is reported. The patient presented with exertional dyspnea, cough and intermittent pleuritic chest pain. Her chest X-ray revealed a peripheral 2 cm mass in the left lower lung zone. Bronchoscopy was normal. She underwent thoracotomy in which a wedge-resection was performed. Histological examination of the specimen demonstrated myoepithelioma of the lung.

Neurogenic tumors of the mediastinum in children

Abstractu2002Neurogenic tumors of the mediastinum are among the most common mediastinal tumors. They include nerve sheath, autonomic nervous system, and paraganglionic tumors and malignant small cell tumor. Neurogenic tumors arise primarily in the paravertebral sulcus. They are most frequently identified as asymptomatic lesions on routine chest X-rays. The majority of symptoms can be related either to compression of neural elements or other intrathoracic structures or to excess production of biogenic amines. Complete surgical excision performed by a thoracotomy approach offers the best opportunity for cure. In the case of tumors with extension into the spinal canal, a combined thoracic and neurosurgical approach should be performed.

Tracheobronchial Foreign Body Aspirations in Children: A Retrospective Analysis of 980 Patients

AbstractBetween January 1987 and May 1997, hospital records of 980 children (587 boys and 393 girls) ≤15 years old referred to our clinic for suspected airway foreign body aspiration were reviewed. Rigid bronchoscopy was performed for all patients. Foreign bodies were successfully removed in 918 (93

Disappointing results of staged arteriovenous reversal (AVR) in severely ischemic extremity

Between 1991 and 1995 the authors performed the arteriovenous fistula (AVF) procedure, which forms the first stage of staged arteriovenous reversal (AVR), in 6 patients (4 with Buergers disease, 2 with atherosclerosis obliterans) with lower extremity arterial occlusive disease. The patients were all men with a mean age of forty-one years. The clinical indications for revascularization included rest pain and nonhealing ischemic ulcer. The results were disappointing: 4 patients with patent fistulas underwent major amputation, and 2 with occluded fistulas underwent toe amputation.

Traumatic Popliteal and Trifurcation Arterial Injuries: How Can We Predict the Ultimate Outcome?

During a sixteen-year period ending in March 1993, 63 patients with 88 popliteal or trifurcation arterial injuries underwent surgical management, and the ultimate outcome was recorded according to both mangled extremity severity score (MESS) and risk clas sification at Dicle University. There were 14 major (22.2%) and 3 minor (4.8%) ampu tations and 4 (6.3%) deaths. Of 40 patients with an ischemic period of more than eight hours, 13 required amputation. According to MESS, there were 28 patients with scores of 7 or more (44.4%). In this group 13 patients required amputation (46.4%), and 8 had a good outcome (28.6%). As regards patients classification by risk factors of nerve injury, soft-tissue injury, and open fracture, 15 of 17 patients having one or less risk factor had a good outcome (88.2%), whereas 20 of 46 patients having two or more risk factors had good outcome (43.5%). A comparison of patients having one or less risk factor with those having three risk factors found statistical significance according to amputation rates (P < 0.05). The difference in amputation rates between 23 patients who were operated on within less than eight hours and 40 patients who were operated on within more than eight hours was statistically nonsignificant (P > 0.05).

Thoracic Outlet Vascular Injuries

Management of vascular injuries at the thoracic outlet and neck continues to be a major problem to the trauma surgeon. Of 47 patients treated over an eighteen-year period, 45 were due to penetrating injuries (41 gunshot [87.2%], 4 stab wounds [8.5%]). In 16 patients shock was present at the time of admission. Five patients were operated on in comatose condition. In 37 patients immediate, and in 10 cases delayed, operation was performed. In 13 patients with arterial injuries, end-to-end anastomosis; in 24, saphenous vein graft; in 6, synthetic graft; in 2, lateral suture; and in 2, ligation were performed. Three subclavian arterial injuries repaired by saphenous vein graft occluded owing to thrombosis, requiring synthetic graft replacement. In 3 axillary arterial injuries, ligation was performed following the operation because of infection. One of these patients underwent amputation. Only 3 of 14 brachial plexus injuries (BPI) were primarily repaired. In only 1 of 3 repaired patients did complete function return. Overall mortality was 5 including 3 comatose patients with carotid injuries and 2 with axillary arterial injuries. In conclusion: (1) Subclavian and axillary artrial injuries may be overlooked by physical examination in the absence of critical ischemia. (2) We recommend ligation instead of revascularization in comatose carotid injury cases. (3) Synthetic grafts may be used, in cases of size discordance or in unstable patients, to end the operation as soon as possible. (4) In associated venous injuries, repair should be preferred to ligation. (5) In the presence of BPI due to gunshot wounds the results are not good in spite of nerve repair, and serious sequelae may remain.